Inflammatory bowel disease is an autoimmune condition where in most cases there are multiple triggers chronically stimulating the immune system over a long period of time in multiple ways and the immune system gets into overloaded, overwhelmed state and loses its ability to function leading to chronic inflammation causes symptoms such as diarrhea, abdominal pain, and other debilitating symptoms and anemia.

According to a study published four days ago in Nature Microbiology, individuals with IBD commonly have dramatic shifts in gut microbiome compared to that of healthy people.

Although it is well known that there are differences in the gut microbiome in IBD patients, this is one of the largest studies to follow the microbiome over a period of time. The most significant difference researchers saw was how the microbiome shifted, describing it as a “volatile dysbiosis.” These patients have a much less stable microbiome than healthy individuals.

Researchers have known that there are some differences in the microbiomes of patients with IBD patients compared to healthy individuals such as fewer beneficial microbes and many times high amounts of Enterobacteriaceae and E. coli.

It is important to know what bacteria are present and how these bacteria shift as the patient’s symptoms exacerbate or improve.

In this study, researchers followed 137 individuals for 2 years, which included patients with ulcerative colitis, Crohn’s disease, and healthy individuals. They collected stool samples from patients every 3 months for up to 2 years and monitored patients’ symptoms.

The research team found that in healthy people, the gut microbiome was much more stable than those with IBD. The patients with IBD had dramatic shifts in their microbiomes with some bacteria disappearing almost completely at times. In addition, over 50% of their microbiome was displaced by other microbes in just a few months. The biggest swings were seen in patients with ileal Crohn’s disease who had had part of their intestine removed to improve their symptoms.

Also, researchers noted that changes in medication to treat IBD affected the microbiome. Individuals who had taken steroids for part of treatment had more fluctuations in their microbiome and those who were experiencing a flare-up in their symptoms were more likely to have dramatic fluctuations in their microbiome.

These results further support the integrative functional medicine approach to assess the microbiome regularly in these patients so one can take an individualized approach to manipulate the microbiome and keep these IBD patients in remission, especially if medications like corticosteroids can be shift the microbiome leading to an exacerbation of the disease.

I shared a study published last month in the Journal of Clinical Gastroenterology in which researchers demonstrated that a specific carbohydrate diet (SCD) can bring patients with active inflammatory bowel disease (IBD) into remission.

In addition, one must look into the other potential environmental triggers that can cause inflammation such as, food sensitivities, toxins, and molds. Also, the nutrient status of the person. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. Finally, there are toxins that can be affect the status of the immune system. These are heavy metals, xenobiotics, as well as the total toxic burden in the body.

Alzheimer’s disease and related disorders (ADRD) are a group of conditions that cause mild cognitive impairment (MCI) or dementia. These conditions affect one’s ability to function socially, personally, and professionally. It’s important to recognize that Alzheimer’s disease begins long before symptoms start just like many other conditions. There is evidence that simple prevention strategies can reduce the risk of ADRD by as much as 50%.

According to a new study published January 30th in JAMA Neurology, Mayo Clinic researchers demonstrated that mentally stimulating activities reduce the risk of new-onset mild cognitive impairment even when performed later in life.

This study found that healthy individuals age 70 or older who were active on a computer, played games, and were involved in craft and social activities had a reduced risk of developing mild cognitive impairment (MCI).

The study included 1,929 cognitively normal participants or an average duration of 4 years. As a result, the researchers discovered that the risk of new-onset mild cognitive impairment decreased by 30% with computer use, 28% with crafts, 23% with social activities, and 22% with playing games.

Furthermore, individuals who performed these activities at least once to twice week had less cognitive decline than those doing the same activities only two to three times a month.

I remember when I was doing a lot of continuing education in postgraduate functional neurology we always talked about “what you fire, you wire”. It’s all about neuroplasticity and stimulating those neural pathways to make them stronger and more efficient.

The benefits of being cognitively engaged were also seen in those with the apolipoprotein E (APOE) gene, which is a genetic risk factor for Alzheimer’s disease and related disorders (ADRD). The researchers found that only computer use and social activities were associated with a reduced risk of MCI in APOE carriers. This is another example of the important role of the environment and epigenetics and not solely focusing on the gene.

When one looks at any condition, the cause is multifactorial and there are addition things health care providers can do to help their patients. I shared a recent study in August in the American Journal of Geriatric Psychiatry researchers at UCLA demonstrated the importance of a healthy diet and regular exercise and its impact on reducing amyloid plaque build-ups that are associated with Alzheimer’s disease.

Previous research has demonstrated the association between diabetes and Alzheimers. A study published earlier this year in the Journal of Alzheimer’s Disease compared decades of research on diabetes and Alzheimer’s disease.

Additionally, a study published in 2015 in the journal, Neurology, demonstrated that resveratrol stabilized amyloid-beta40 (Abeta40) in patients with mild to moderate Alzheimer’s disease. This biomarker declines when the disease progresses.

Another study published in 2015 in JAMA Neurology demonstrated a significant association between vitamin D insufficiency and cognitive decline specifically seen Alzheimer’s disease and dementia.
B vitamins and omega-3 fatty acids are also crucial nutrients involved in numerous metabolic processes that play a significant role in cognitive health. There was an interesting study published in the Journal of Alzheimer’s Disease. Researchers found a link between Omega-3 levels, homocysteine, and brain atrophy rates. Homocysteine plays a role in regulating phospholipid metabolism and omega-3 distribution by the methionine cycle. As a result, B vitamins are essential for the synthesis of phospholipids. This study demonstrated when omega-3 levels are in an upper normal range, B vitamins slow cognitive decline and brain atrophy.

Glutathione is also essential for neurodegenerative disease. This powerful antioxidant has been found to be depleted in the brain of neurodegenerative disorders. Providing antioxidant support with NAC or glutathione are essential for neurodegenerative disorders because the body’s cells are more susceptible to damage and death after 40 years of age.

Curcumin also provides protection amyloid-induced toxicity. There are only a few natural products that have demonstrated the wide range of protective properties as curcumin. Additional brain supportive nutrients include magnesium l-threonate, acetyl-l-carnitine, and glycerophosphocholine.

Atrial fibrillation (AF) is an increasing common cardiac rhythm disturbance that can lead to stroke and congestive heart failure. It can be facilitated by inflammation and oxidative stress and in approximately 30% of patients undergoing cardiac procedures suffer from post-operative AF.

According to a study published 2 days ago in BMC Cardiovascular Disorders, researchers in Finland conducted a systematic review of vitamin C for preventing AF in high risk patients. They analyzed 14 randomized control trials consisting of 2006 patients who had cardiac surgery, and one study with 44 patients that had investigated the recurrence of AF after a successful cardioversion.

Interestingly, the 5 studies in the USA found no effect of vitamin C against post-operative AF. On the other hand, the 9 studies performed outside of the USA found a mean reduction of 44 and a study in Greece found that vitamin C decreased the risk of AF recurrence by 87%.

In addition, in the non-US studies, vitamin C reduced the length of hospital stay by 12.6% and intensive care unit stay by eight percent.

One must keep in mind that some of the surgery patients in the non-US studies were administered oral vitamin C orally whereas some in the US studies were given intravenous vitamin C.

As a result, oral vitamin C at 1-2 grams a day decreased post-operative AF by 73% and shortened the length of hospital stay by only 7%. Intravenous vitamin C only decreased AF by 36% but shortened the length of hospital stay by 16%. In conclusion, intravenous vitamin C administration had a greater on reducing the hospital stay but less effective for reducing the occurrence of post-operative AF.

Vitamin C is a very inexpensive powerful nutrient and antioxidant and should be considered for cardiac surgery patients. Other nutrients to support the disruption of metabolic processes and preserve energy substrates include a multivitamin/mineral formula, fish oil, D-ribose, CoQ10, carnitine, and magnesium.

There has been a significant increase in the incidence of autoimmune disorders over the past several decades. For every 1,000 Americans, approximately one and five people have Type 1 diabetes.
Type 1 diabetes typically develops when the body’s own immune system attacks the pancreas and prevents the production of insulin.

There has been increasing evidence of the correlation between the gut and Type I diabetes. Alessio Fasano, MD brought this to everyone’s attention in “Surprises from Celiac Disease” published in Scientific American August 2009. In this article he discusses the role of zonulin and intestinal permeability and its role in many autoimmune diseases such as celiac disease, type I diabetes, MS, and rheumatoid arthritis.

According to a new study published last week in the Journal of Clinical Endocrinology & Metabolism, researchers demonstrated that patients with Type 1 diabetes exhibit a specific inflammatory profile and microbiome composition that is different from healthy individuals as well as other autoimmune conditions suggesting the gut’s potential role in the development of Type I diabetes.
This is the first study to analyze the inflammatory profile, gut microbiome and their association on duodenal mucosa of patients with Type I diabetes in comparison with patients with celiac disease and healthy individuals.

In the study, researchers examined the microbiome of 54 individuals who underwent endoscopies and biopsies of the small intestine. The participants with Type 1 diabetes showed significantly more inflammation of the gastrointestinal mucosa associated to 10 specific genes which was different then the participants with celiac disease and healthy individuals. This may result in an increased antigenic load causing altered immune activation and intestinal inflammation that may contribute to the destruction of pancreatic β cells. In addition, those with Type 1 diabetes also had a distinct microbiome composition from the other two groups. Patients with Type I diabetes had a decrease in Proteobacteria and an increase in Firmicutes bacteria.

Autoimmunity can occur a few different ways. First, there can be a mistaken identity and the body attacks itself. This can occur with a virus where there is tissue destruction and it appears to be foreign to the body. Second, is called molecular mimicry. This occurs when the body makes an antibody (a protein in the body that attacks objects in the body that appear to be foreign) to a specific antigen. These antigens can resemble certain proteins in the body and the antibodies attack our body’s own tissues. Third, is the development of the T cells (the immune system). This can be affected by genetics, stress, and environmental triggers.

Environmental triggers are what integrative doctors mainly work with in functional medicine. These can be food triggers such as gluten or food sensitivities that can trigger inflammation as well as anything coming in with the food such as toxins or molds. In addition, the nutrient status of the person. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. Also, gut health. This includes “leaky gut” and dysbiosis. Finally, there are toxins that can be affect the status of the immune system. These are heavy metals, xenobiotics, as well as the total toxic burden in the body.

It has not been determined if Type 1 diabetes’ signature effect on the gut is caused by or the result of the body’s own attacks on the pancreas but It is essential to investigate into these factors for all patients with autoimmunity.

Approximately 2% of American children experience symptoms among the autism spectrum including deficits in social interaction, impairment in verbal and nonverbal communication, and stereotyped patterns of activities. Many families seek integrative doctors to investigate food sensitivities, environmental toxins, nutritional deficiencies, and metabolic imbalances not seen on the usual laboratory testing.

According to a study published 2 weeks ago in The Journal of Child Psychology and Psychiatry, researchers demonstrated the efficacy of vitamin D supplementation in autism spectrum disorder (ASD). Vitamin D has an essential role in neurodevelopment, gene regulation, immune function, inflammation, and overall health. Previous studies have shown a link between the risk of ASD and vitamin D insufficiency. In addition, vitamin D deficiency during pregnancy is linked with adverse effects in the fetus and an increased risk of autism.

This study was a 4-month, double-blinded, randomized, placebo-controlled trial including 109 children with ASD from outpatient clinics and five private autism treatment centers. Serum vitamin D levels were measured at the beginning and at the end of the study.

Vitamin D supplementation was dosed at 300 IU per kg/day and not to exceed 5,000 IU/day. The autistic symptoms of the children improved significantly following 4-months vitamin D supplementation, which was not seen in the placebo group. There was a significant improvement in irritability, hyperactivity, social withdrawal, stereotypic behavior, and inappropriate speech as well as significantly fewer autistic mannerisms such as, repetitive hand movements, creation of noises, and jumping.

This is the first double-blinded RCT demonstrating the efficacy of vitamin D supplementation in children with ASD. Nutrition is incredibly important and can be difficult to accomplish for children with Autism Spectrum Disorders. It can be difficult for some parents to get their kids to eat a nutrient dense diet. Children are growing, the brain is developing and there tends to be some nutritional gaps due to lack of variety in their diet, soil deficiencies, or eating processed, convenience foods. Children may be influenced by advertising or packaging and sometimes pick products to eat. A well balanced diet consisting of whole foods should be the number one priority and foundation of their health but supplements can definitely fill in some of the gaps to support optimal health.

The level of nutrient intake that maintains the best possible health is highly variable from person to person. Lifestyle choices and environmental exposures filtered through genetic predisposition are fundamental factors in ASD, and a successful treatment approach must include investigation into these factors. It is important to assess the nutrient status of the child. This can be the antioxidant status, vitamins, essential fatty acids, vitamin D, B12, folate, calcium, etc. An organic acid test is also a great test to assess nutrient deficiencies, oxidative stress, and detoxification impairment as well as stool testing to assess the gut microbiome.

According to a recent study from the University of Georgia published in the Journal of the International Neuropsychological Society, researchers demonstrated the effect of lutein and zeaxanthin on neurocognitive functioning. The research team used fMRI technology to examine how levels of these compounds affect brain activity.

Previous research has demonstrated the benefits of lutein and zeaxanthin on eye health and more research is emerging on their benefits on cognition in older adults.

In this study researchers used a functional MRI to monitor the brain activity of over 40 adults between 65 and 86 years old and found that individuals with higher levels of lutein and zeaxanthin did not require as much brain activity to complete the task.

The level of lutein and zeaxanthin were assessed through serum and noninvasive flicker photometry. There is a natural deterioration process of the brain as people age, but the brain compensate to some degree by increasing brain activity to maintain the same level of cognitive performance.

As a result, individuals with lower levels of lutein and zeaxanthin used more brain power and relied on different parts of the brain in order to remember the word pairings they were taught. On the other hand, those with higher levels minimized brain activity to complete the task.

I also shared a study a month ago in the journal Redox Biology, in which researchers demonstrated that n-acetyl-cysteine (NAC) may prevent the metabolic declines associated with aging.

Patients and healthcare providers are always seeking prevention strategies and ways to minimize age related memory decline in older adults. Dietary modification and nutritional supplements are the best strategies to help to support this.

Lutein, zeaxanthin, NAC, vitamin D, and fish oils can be used to provide protective measures against the natural aging process in older adults. An organic acid test is a great test to identify nutrient deficiencies, oxidative stress, and detoxification impairment. In addition, assessing methylation cofactors such as folate and B12 are also important as these are common deficiencies in the elderly.

According to a new study published 3 days ago in JAMA, the U.S. Preventive Services Task Force (USPSTF) recommended the use of statins for primary prevention of cardiovascular disease.

They recommend the use of low- to moderate-dose statins in adults ages 40 to 75 years without a history of cardiovascular disease (CVD) who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater.1

The USPSTF concluded that the harm of low- to moderate-dose statin use in adults aged 40 to 75 years is minimal.

In contrast, recent previous studies demonstrate how the education on statins are deceptive and create the appearance that are safe and effective in prevention of cardiovascular disease. There is no questions that statins are effective at reducing cholesterol levels, but they have failed to substantially improve cardiovascular outcomes or have succeeded in reducing the risk of mortality. 2 The role of high cholesterol as an etiological factor in cardiovascular disease (CVD) has been a source of controversy and debate for decades. Studies have demonstrated that older adults with low levels of cholesterol are just as atherosclerotic as those with high levels.3

Also, another study demonstrated how statins stimulate atherosclerosis and heart failure. This study suggests that statins may be causative in coronary artery calcification and can act as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q10 and ATP generation.4

Statins inhibit the synthesis of vitamin K2 which protects the arteries from calcification. In addition, statins inhibit the biosynthesis of selenium containing proteins. This impairment may be a factor in congestive heart failure as a selenium deficiency is seen with cardiomyopathies.

At the end of the day protocol driven treatment like this fail. Each person’s biochemical individuality exerts a major influence on his or her health. The level of nutrient intake that maintains the best possible health is highly variable from person to person. Lifestyle choices and environmental exposures filtered through genetic predisposition are fundamental factors in the expression of disease and a successful treatment approach must include investigation into these factors.

Celiac disease is an autoimmune disease triggered by the consumption of gluten-containing foods. The medical approach for celiac disease is a lifelong gluten-free diet. However, recent evidence demonstrates that a gluten-free diet may not be enough to prevent many complications associated with this disease.

According to a new study published last week in the Journal of Pediatric Gastroenterology and Nutrition, approximately 20% of children with celiac disease have intestinal abnormalities after one year following a strict gluten free diet.

In this study, researchers reviewed medical records of 103 children and adolescents with celiac disease. The main treatment for celiac disease is a gluten-free diet, which was followed for an average of 2.4 years. In addition, the children also had endoscopy and biopsy at least two times at diagnosis and after one year on a gluten-free diet.

The study focused on the rate of persistent celiac enteropathy which was present in 19% of the children. These results suggest that 1 out of 5 children with celiac disease may have persistent enteropathy, despite following their recommended gluten-free diet which can lead to long-term effects and complications.

Few studies have looked at the effect of non-gluten proteins and celiac disease. An all-too-common contributor to non-responsive celiac disease is cross-reactivity with other foods. Assessing gluten-associated cross-reactive foods is essential for patients with gluten sensitivity and celiac disease since these patients are sensitized to a broad range of dietary proteins due to enzyme dysfunction, villi damage and other disorders.

As a result, many functional abnormalities can persist such as increased gut permeability, pancreatic insufficiency, small-intestinal bowel overgrowth, nutritional deficiencies, hypochlorhydria, and allergies.

Patients with celiac disease many times have to do more than just follow a gluten-free diet to maintain optimal health. Although a majority of celiac patients feel better after implementing a gluten-free diet, they continue to have poor nutrient status. Celiac disease attacks and damages the villi of the small intestine, resulting in the body not being able to absorb all the nutrients it needs. The most common deficiencies are vitamin D, calcium, folate, vitamin B12 and iron. It is importance to assess the nutrient status. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. In addition, it is essential to use stool testing that can assess the overall function of the gastrointestinal tract to rule out autoimmune triggers, digestion and absorption markers, as well as inflammatory and immune markers.

New research published in The FASEB Journal provides more evidence that fish oil supplementation and an additional benefit for Alzheimer’s disease by improving the function of the glymphatic system. This system is responsible for clearing waste from the brain and metabolites such as amyloid-β peptides.

In this study researchers found fish oil supplementation significantly promotes the clearance function of the lymphatic system and Aβ clearance from the brain. In addition, omega-3 fatty acids help maintain the brain homeostasis which essential for neurological diseases, traumatic brain injury, and sleep disturbances.

There was another study published in July 2015 in The FASEB Journal where researchers saw a clearance of amyloid-beta protein and reduced inflammation in the neurological tissues with fish oil supplementation.

Omega-3 fatty acids are also essential nutrients involved in numerous metabolic processes that play a significant role in cognitive health. There was an interesting study published in January in the Journal of Alzheimer’s Disease in which researchers found a link between Omega-3 levels, homocysteine, and brain atrophy rates. Homocysteine plays a role in regulating phospholipid metabolism and omega-3 distribution by the methionine cycle. As a result, B vitamins are essential for the synthesis of phospholipids. This study demonstrated when omega-3 levels are in an upper normal range, B vitamins slow cognitive decline and brain atrophy.

In addition to omega-3 fatty acids there are also several nutrients to consider. A study published last September in the journal, Neurology, demonstrated that resveratrol stabilized amyloid-beta40 (Abeta40) in patients with mild to moderate Alzheimer’s disease. This biomarker declines when the disease progresses.

Another study published last year in JAMA Neurology demonstrated a significant association between vitamin D insufficiency and cognitive decline specifically seen Alzheimer’s disease and dementia.
In addition, studies have also demonstrated low levels of magnesium in the brains of patients suffering from Alzheimer’s disease. Magnesium L-threonate is a unique patented form of magnesium that has the ability to cross the blood brain barrier and increase learning ability, working memory, as well as short- and long-term memory.

Glutathione is also essential for neurodegenerative disease which I highlighted last week and its importance in the aging. This powerful antioxidant has been found to be depleted in the brain of neurodegenerative disorders. The extent of glutathione depletion appears to mirror the severity of the disease and is the earliest known indicator of degeneration. The brain has difficulty handling significant amounts of oxidative stress due to the presence of polyunsaturated fatty acids and low levels of antioxidants such as glutathione. In conclusion, providing antioxidant support with NAC or glutathione can also provide a beneficial effect in all neurodegenerative disorders.

Glutathione is a powerful antioxidant that helps support detoxification pathways by providing protective measures against environmental stresses, air pollutants, heavy metals, and pharmaceuticals. Numerous condition has been associated with a decline of detoxification pathways such as cardiovascular disease, diabetes, cancer, and neurodegenerative conditions.

According to a new study published in the journal Redox Biology, researchers at Oregon State University demonstrated that n-acetyl-cysteine (NAC) may help maintain glutathione levels and prevent the metabolic declines associated with aging. This powerful antioxidant declines with age and helps the body resist the stresses of everyday life.

In this animal study, researchers demonstrated that cells from younger animals are more resistant to stress than those from older animals. In younger animal cells stress doesn’t cause a rapid loss of glutathione as seen in older animals. As a result, prophylactic use of NAC increased glutathione levels in the older cells and offset cell death.

I also shared a study earlier this year published in June in PLOS ONE in which researchers from Thomas Jefferson University demonstrated a potential benefit of n-acetylcysteine (NAC) in patients with Parkinson’s disease. The study showed that patients receiving NAC improved both mental and physical abilities with brain imaging studies that tracked the levels of dopamine.

This demonstrates that NAC may have a unique physiological effect on the brain that alters the disease process and improves the function of dopamine neurons and offers a new approach for managing patients with Parkinson’s disease.

Glutathione is an important antioxidant which has been found to be depleted with the natural aging process and also seen in patients with neurodegenerative conditions. The extent of glutathione depletion appears to mirror the severity of disease and is the earliest known indicator of degeneration.

N-acetyl-cysteine can definitely play a significant a role in preventing the increased toxicity faced with aging and the body’s reduced ability to eliminate toxins. NAC has the ability to improve the metabolic resilience that lost with the aging process as well as it detoxification support. Increasing NAC can reduce the toxicity of some prescription drugs, cancer chemotherapies, and support other health issues. Therefore, using NAC as prophylactic support instead of a treatment can allow glutathione levels to be maintained to provide protective measures against the natural aging process in older adults.

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DISCLAIMER This information is provided for Educational Purposes Only and has NOT been designed to diagnose, treat or cure any health conditions. This information is not a substitute for acute medical advice. The U.S. Food and Drug Administration have not evaluated statements about these health topics or any suggested product compositions.